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Merill's Atlas Volume 1 > Chapter 4: Upper Limb > Flashcards

Chapter 4: Upper Limb Flashcards

1
Q

The proxi­mal row of carpal , which is nearest to the forearm, contains

A

the scaphoid, lunate, tri­ quetrum, and pisiform

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2
Q

The distal row of the carpals includes

A

the trapezium, trapezoid, capi­ tate, and hamate.

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3
Q

Articulates with the 3rd metatarsal and is the largest and most centrally located carpal

A

Capitate

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4
Q

Wedge shape and exhibit a prominent of hook located on the anterior surface.

A

Hamate

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5
Q

A triangular depression is located on the posterior surface of the wrist and is visible when the thumb is abducted and extended. This depression, known as the _____________,is formed by the ten­dons of the two major muscles of the thumb.

A

Anatomic snuffbox

 * Tenderness in the snuffbox area is a clinical sign suggesting fracture of the scaphoid-the most commonly fractured carpal bone.
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6
Q

a strong fibrous band, attached medially to the pisiform and hook of hamate and laterally to the tuber­cles of the scaphoid and trapezium.

A

Flexor Retinaculum

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7
Q

Results from com­pression of the median nerve inside the carpal tunnel.

A

Carpal tunnel syndrome

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8
Q

Interphalangeal articulations

A

synovial hinge type and allow only flexion and extension

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9
Q

Metacarpophalangeal

A

Synovial, Ellipsoidal type

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10
Q

Carpometacarpal, first digit

A

Synovial, Saddle

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11
Q

Carpometacarpal, 2nd to 5th digit

A

Synovial, gliding

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12
Q

Intercapal

A

Synovial, gliding

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13
Q

Radiocarpal

A

Synovial, Ellipsoidal

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14
Q

Radioulnar, Proximal and Distal

A

Synovial, Pivot

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15
Q

Humeroulnar

Humeroradial

A

Synovial, hinge

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16
Q

The fat pads become significant radiographically when an elbow injury causes effusion and dis­places the fat pads or alters their shape. Visualization of the _____________ is a reliable indicator of elbow pathology.

A

Posterior fat pads

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17
Q

Fluid filled cyst with a wall of fibrous tissue

A

Bone Cyst

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18
Q

Displacement of a bone from the joint space

A

Dislocation

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19
Q

Disruption in the continuity of bone

A

Fracture

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20
Q

Fracture at the base of the first metacarpal

A

Bennet’s Fracture

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21
Q

Fracture at the base of the fifth metacarpal

A

Boxer’s

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22
Q

Fracture of the distal radius and ulnar styloid with posterior displacement

A

Colle’s

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23
Q

Fracture of the distal radius and ulnar styloid with anterior displacement

A

Smith’s

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24
Q

Impacted fracture with bulging of the periosteum

A

Torus/Buckle

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25
Q

Accumulation of fluid in the joint associated with an underlying condition

A

Joint effusion

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26
Q

Form of arthritis marked by progressive cartilage deterioration in synovial joints and vertebrae

A

Osteoarthritis or Degenerative Joint Disease

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27
Q

Inflammation of bone due to a pyogenic infection

A

Osteomyelitis

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28
Q

Increased density of atypically soft bone

A

Osteopetrosis

29
Q

Loss of bone density

A

Osteoporosis

30
Q

Chronic, systemic, inflammatory collagen disease

A

Rheumatoid Arthritis

31
Q

New tissue growth where cell proliferation is uncontrolled

A

Tumor

32
Q

Malignant tumor arising from cartilage cells

A

Chondrosarcoma

33
Q

Benign tumor consisting of cartilage

A

Enchondroma

34
Q

Malignant tumor of bone arising in medullary tissue

A

Ewing’s Sarcoma

35
Q

Malignant, primary tumor of bone with bone or cartilage formation

A

Osteosarcoma

36
Q

When joint injury is suspected, an AP projection is recommended instead of a PA projection.

True or False?

A

True

37
Q

Lewis’ suggested directing the central ray ___________ degrees along the long axis of the thumb toward the wrist to demonstrate the first metacarpal free of the soft tissue of the palm.

A

10-15 degrees

38
Q

This projection is commonly performed to demonstrate arthritic changes, fractures, di placement of the first CMC joint, and the Bennett’s fracture.

A

Robert Method
- 0 degrees to carpometacarpal joint.

Long-Rotert modification.
15 degrees cephalad to carpometacarpal joint.

Lewis modification.
10 to 15 degrees cephalad to the metacarpophalangeal joi

39
Q

When hyperextension of the wrist is not contraindicated, this projection provides a clearer image of the first CMC joint than the standard AP pro­jection.

A

Burman Method

 * Hyperextended hand and abducted thumb position for AP of the first car­pometacarpal joint
  * CR - 45 degree to 1st CMC toward the elbow
40
Q

This projection is useful for the diagnosis of ulnar collateral ligament (UCL) rupture in the Mcp joint of the thumb, also known a “skier’s thumb.”

A

Folio Method

41
Q

When the MCP joints are under exami­nation, what will you do if the patient cannot extend the hand enough to place its palmar surface in contact with the IR?

A

the position of the hand can be reversed for an AP projection.

42
Q

describe a special exposure technique for imag­ing early rheumatoid arthritis

A

Clements and Nakayama

43
Q

Lane, Kennedy, and Kuschner’ recommend the inclusion of a reverse oblique projec­tion to better demonstrate ________________. This projection is accomplished by having the patient rotate the hand 45 degree medially (internally) from the palm-down position.

A

severe metacarpal deformities or fractures.

44
Q

What projection superimpose the metacarpals but demonstrates almost all of the individual phalanges. The most proximal portions of the proximal pha­ langes remain superimposed

A

Fan Lateral

45
Q

Sometimes referred to as the ball-catcher’s position, assists in detecting early radiologic changes needed to diagnose rheumatoid arthritis.

A

Norgaard method

 * Stapczynski recommended this projection for the demon tration of fracture of the ba e of the fifth metacarpal.
46
Q

To better demonstrate the scaphoid and capitate, Daffner, Emmerling, and Buterbaugh’ recommended angling the central ray when the patient is positioned for a PA radiograph. A central ray angle of 30 degree toward the _____ elongates the scaphoid and capitate, whereas an angle of 30 degree toward the ______ only elongates the capitate.

A

Elbow

Fingertips

47
Q

Why is it that the carpal interspaces are better demonstrated in the AP image than the PA image.

A

Because of the oblique direction of the interspaces, they are more closely par­allel with the divergence of the x-ray
beam

48
Q

Fiollez was the first to describe a small bony growth occurring on the dorsal surface of the third CMC joint. He termed the condition _____________ and found that it is demonstrated best in a lateral position with the wrist in palmar flexion

A

carpe bossu (carpal boss)

49
Q

This projection demonstrates the carpals on the lateral side of the wrist, particularly the trapezium and the scaphoid. The scaphoid is superimposed on itself in the direct PA projection.

A

PA Oblique Projection, Lateral Rotation

 * When the scaphoid is under examina­tion, adjust the wrist in ulnar deviation.
50
Q

This position separates the pisiform from the adjacent carpal bones. It also gives a more distinct radiograph of the triquetrum and hamate.

A

AP Oblique Wrist, Medial Rotation

51
Q

This position corrects foreshortening of the scaphoid, which occurs with a perpen­dicular central ray. It also opens the spaces between the adjacent carpals.

A

PA Projection, Ulnar Deviation

52
Q

opens the interspaces between the carpals on the medial side of the wrist

A

PA Wrist, Ulnar Deviation

53
Q

PA AXIAL PROJECTION

Stetcher Method

A

The 20-degree angulation of the wrist places the scaphoid at right angles to the central ray so that it is projected without self-superimposition

Variations
☑️ by placing the IR and wrist horizontally and directing the central ray 20 degrees toward the elbow

☑️ the wrist may be angled inferiorly, or from the hor­izontal position the central ray may be angled toward the digits

☑️ is to have the patient clench the fist. This elevates the distal end of the
caphoid 0 that it lies parallel with the IR; it also widens the fracture line. The wrist is positioned as for the PA projection, and no central ray angulation is used

54
Q

PA wrist with ulnar deviation, With the hand and wrist in

the same position for each projection, four separate exposure are made at 0, 10, 20, and 30 degrees cephalad.

A

Rafert-Long Method

* minimal superimposition of scaphoid, technique for diagnosis of scaphoid fracture

55
Q

clearly demontrates the trapezium and its articulations with the adjacent carpal bones
Position:
Place a 45-degree sponge wedge against the anterior surface, and rotate the hand to come in contact with the sponge, with ulnar deviation if patient can handle.

A

PA Axial Oblique wrist for trape­zium: Clements-Nakayama method

56
Q

Angulation for tangential carpal bridge

A

Directed to a point about 1 and half inches (3.8 cm) proximal to the wrist joint at a caudal angle of 45 degrees

57
Q

___________ of the hand crosses the radius over the ulna at its proximal third and rotates the humerus medially, resulting in an oblique projection of the forearm

A

Pronation

58
Q

Griswold’ gave two reasons for the impor­tance of flexing the elbow 90 degrees:

A

( l ) the olecranon process can be seen in profile,

(2) the elbow fat pads are the least compressed.

59
Q

When injury to the soft tissue around the elbow is suspected, the joint should be flexed only _______________
for lateral elbow. This partial flexion does not compress or stretch the soft tructures as does the full 90-degree lateral flexion.

A

30-35 degrees

60
Q

an oblique projection of the elbow with the coronoid process projected free of superimposition

A

AP Oblique, Medial Rotation (Elbow)

61
Q

oblique projection of the elbow with the radial head and neck projected free of superimposition of the ulna

A

AP Oblique, Lateral Rotation (Elbow)

62
Q

For demonstration of the entire circumference of the radial head free of superimposition, what four projections with varying positions of the hand are performed.

A

☑️lateral elbow, radius with hand supinated as much as possible
☑️Lateral elbow,radius with hand lateral
☑️Lateral elbow, radius with hand pronated
☑️Lateral elbow radius with hand internally rotated

63
Q

Greenspan and Norman’ reported that the radial head can be projected more clearly with reduced superimposition by directing the central ray ___________ medially (toward the shoulder)

A

45 degrees

64
Q

This projection demonstrates the epi­ condyles, trochlea, ulnar sulcus (groove between the medial epicondyle and the trochlea), and olecranon fossa. This projection is used in radiohumeral bursitis (tennis elbow) to detect otherwise obscured calcifications located in the ulnar sulcus.

A

PA Axial Projection of the Elbow

65
Q

The projection demonstrates the olecra­non process and the articular margin of the olecranon and humerus .

☑️Arm at an angle 40-45 degrees angle from vertical
☑️CR - perpedicular to olecranon process to demonstrate dorsum of the olecranon process
*20 degrees toward wrist - to demonstrate the curved extremity and articular margin of the olecranon process

A

PA Axial Projection (Olecranon Process)

66
Q

The lateral projection demonstrates the entire length of the humerus. A true lateral image is confirmed by _______________.

A

Superimpose epicondyles

67
Q

Place the upper margin of the IR

approximately above the humeral head for humerus position

A

1 and 1/2 inches (3.8cm)

68
Q

Recumbent position for AP humerus, note that the hand is _________.

A

Supinated

69
Q

Recumbent position for lateral humerus. Note the posterior aspect of patient’s hand against ______.

A

The thigh

Merill's Atlas Volume 1 (7 decks)

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